The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection

Ferrer, Miquel; Martín‐Loeches, Ignacio; Zampieri, Fernando G.; Rodríguez, Alejandro; Curcio, Daniel; Cordero, Maria Lourdes; Paulino, C.; Salluh, Jorge I.; Fernandez, Ricardo; Arroyo, J.; Gabriela, M.; Álvarez, Regino Rodríguez; Reyes, A.; Dellera, Christian; Molina, Fernando; Franco, Daniel; Parada, Edwin Giovanny Chapeta; Yepez, Estuardo Salgado; Oña, F. P.; Tutillo, D. M.; Barahona, D.; Lerma, F. Álvarez; Alvarez, Alfredo Aisa; Gallego, Juan Manuel; Morillas, Francisco Jiménez; Aguilar, Ana; Lorenzana, M. L.; Iniesta, Rafael Sánchez; Almirall, Jordi; Albaya, Antonio; Santana, S. Ruiz; Fernández, C. Rodríguez; Potro, M. A.; Vidal, Pablo; Jiménez, Beatriz; Sierra, Rafael J.; Ortíz, Marta; Cruza, N.; Olaechea, Pedro; Zirena, Ana Carolina Caballero; Gonzalez, P. P.; Gomez, Trillo; Crespí, Lorenzo Socías; Galleymore, Paula Ramírez; Marcos, Ricard; Palazón, C.; Rueda, Bernardo Gil; Ballesteros, Juan; Arnilla, M.P. Gracia; Socías, Antònia; Amador, J.; Silvero, Esperanza Molero; Redin, L. Macaya; Elson, M. Zamora; Pericas, L. Cabre; Rodriguez, J; Nieto, María; Torres, Antoni; Molinos, Elena; Josefi, A.; Catorze, Nuno; Póvoa, Pedro; Candeias, C.; Coelho, Luís; André, Paulo; Ángel, Miguel; García, Gema María García; Ramírez, Catalina Sánchez; Calizaya, Milagros; Estella, Ángel; A, Albis Cecilia Hani; Aguilar, Gerardo; Torrents, Eva; Puente, M. Gurpegui; Sánchez, Adriana; Lisboa, Thiago; Azambuja, Pedro Mendes de; Knibel, Marcos Freitas; Ranzani, Otávio T.; Camargo, Luiz de; Junior, A. P.; Ferreira, Catarina; Lobo, Suzana Margareth; Rabello, Lígia Sarmet Cunha Farah; Park, M.; Carvalho, Agr; Valencia, Mauricio; Castro, A. González; López, A. A.; Caballero, Jesús; Nseir, Saad; Jaffal, Karim; Parmentier-Decrucq, Erika; Preau, Sébastien; Rousselin, C.; Blazejewski, Caroline; Masse, Juliette; Robriquet, Laurent; Satre-Buisson, Léa; Mira, Jean‐Paul; Martin, N.; Lepecq, Raphaël; Mentec, Hervé; Girault, Christophe; Marchalot, Antoine; Messika, Jonathan; Ricard, Jean Damien; Séguin, Philippe; Mégarbane, Bruno; Valade, Sandrine; Azoulay, Élie; Boussekey, Nicolas; Leroy, Olivier; Reignier, Jean; Clavel, M.; Pichon, Nicolas; Baudry, Thomas; Argaud, Laurent; Beuret, Pascal; Hssain, Ali Ait; Nyunga, Martine; Alves, Isabelle; Dewavrin, Florent; Brunin, Guillaume; Mérat, Stéphane; Pasquier, Pierre; Brun, Francisco; Palud, Aurore; Voisin, B.; Grenot, Romaric; Grunderbeeck, Nicolas Van; Thévenin, Didier; Benoît, Michel; Philippart, François; Frat, Jean‐Pierre; Coudroy, Rémi; Cabaret, P.; Ledein, M.; Slimane, F. Z.; Miguel-Montanes, Romain; Weiss, Nicolas; Bolgert, Françis; Just, B.

doi:10.1007/s00134-019-05797-6

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…Multidrug resistant bacteria (MDR) bacteria and inappropriate initial antibiotic treatment are well-known risk factors for mortality in VAP patients [28,29]. Although the incidence of MDR, and inappropriate initial antibiotic treatment was lower in COVID-19 patients, as compared to the two other groups, the relationship between VAP and mortality was only significant in COVID-19 patients.…”

Section: Impact Of Sars-cov-2 Infection On the Relationship Between Vap And Mortalitymentioning

confidence: 99%

Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

et al. 2021

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Background Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. Methods Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox’s regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. Findings Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 (adjusted HR 1.70 (95% CI 1.16–2.47), p = 0.006), and influenza groups (1.75 (1.03–3.02), p = 0.045), but not in the no viral infection group (1.07 (0.64–1.78), p = 0.79). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. Interpretation VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693.

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Section: Impact Of Sars-cov-2 Infection On the Relationship Between Vap And Mortalitymentioning

confidence: 99%

Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

et al. 2021

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“…VA-LRTI as a whole might have some common ground with both VAT and VAP [ 3 ]. Martin-Loeches et al [ 44 ] recently evaluated the clinical significance of VA-LRTI in patients with cardiovascular failure manifesting in a Sequential Organ Failure Assessment (mSOFA) cardiovascular score of 4 (at the time of the VA-LRTI diagnosis and present for at least 12 h). As expected, patients with cardiovascular failure had a higher mortality rate than those without it.…”

Section: Organ Failure Severity In Nosocomial Pneumoniamentioning

confidence: 99%

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients

Martín‐Loeches

2020

Antibiotics

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It is widely known that pneumonia (either community acquired or hospital acquired, as like ventilator associated pneumonia (VAP)), is the most frequent type of severe infection and continues to pose a significant burden on healthcare services worldwide. Despite new diagnostic developments, most pneumonia cases continue to be difficult to diagnose clinically, partly due to acquired antibiotic resistance and the lack of a ‘gold standard’ method of diagnosis. In other words, the lack of a rapid, accurate diagnostic test, as well as the uncertainty of the initial etiologic diagnosis and the risk stratification, results in empirical antibiotic treatments. There are significant changes in the aetiology of patients with ventilator associated lower respiratory tract infections (VA-LRTI), which are characterised by a higher incidence of multi drug resistant organisms. Evidence suggests that when patients with VA-LRTI develop organ failure, the associated mortality can be exceptionally high with frequent complications, including acute respiratory distress syndrome, acute kidney injury, and septic shock. Appropriate antibiotic treatments must consider that the present cardiovascular failure seen in patients has a different association with the patient’s mortality. Unlike patients with less severe clinical presentations, who have a higher chance of survival when the appropriate antibiotics are administered promptly, for patients with a severe subtype of the disease, the appropriateness of antibiotic treatment will impact the patient’s outcome to a lesser extent. The present review highlights certain factors detectable at the time of admission that could indicate patients who are at a high risk of bacteraemia and who, therefore, merit more intense therapy and stratified care.

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“…In addition, we also showed that adequate antibiotic therapy had a significant impact on outcomes. And recently, we found that the impact of the adequacy of antibiotic therapy on mortality was conferred only to patients without cardiovascular failure [4].…”

Section: Published Inmentioning

confidence: 98%

A way towards ventilator-associated lower respiratory tract infection research

2020

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The association of cardiovascular failure with treatment for ventilator-associated lower respiratory tract infection

Cited by 15 publications

References 33 publications

Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

Current Concepts in Community and Ventilator Associated Lower Respiratory Tract Infections in ICU Patients

A way towards ventilator-associated lower respiratory tract infection research

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